Basic Surgery (100q).1

100 Questions | Total Attempts: 2835

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Basic Surgery (100q).1

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Questions and Answers
  • 1. 
    • A. 

      Lean body mass increases.

    • B. 

      Total body water increases.

    • C. 

      Adipose tissue decreases.

    • D. 

      Body weight decreases.

  • 2. 
    The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
    • A. 

      Hypermetabolism.

    • B. 

      Fever

    • C. 

      Tachypnea

    • D. 

      Hyperphagia

    • E. 

      Negative nitrogen balance.

  • 3. 
     Shock can best be defined as:
    • A. 

      Hypotension

    • B. 

      Hypoperfusion of tissues.

    • C. 

      Hypoxemia

    • D. 

      All of the above.

  • 4. 
    • A. 

      Cytokines act directly on target cells and may potentiate the actions of one another.

    • B. 

      Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.

    • C. 

      Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.

    • D. 

      Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates

  • 5. 
    All of the following are true about neurogenic shock except:
    • A. 

      There is a decrease in systemic vascular resistance and an increase in venous capacitance.

    • B. 

      Tachycardia or bradycardia may be observed, along with hypotension.

    • C. 

      The use of an alpha agonist such as phenylephrine is the mainstay of treatment

    • D. 

      Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

  • 6. 
    • A. 

      Dobutamine

    • B. 

      Sodium nitroprusside.

    • C. 

      Pneumatic antishock garment.

    • D. 

      Intra-aortic balloon pump

  • 7. 
    • A. 

      There are no primary alterations in cardiovascular signs

    • B. 

      Signs of increased intracranial pressure may be masked by the hyponatremia.

    • C. 

      Oliguric renal failure is an unlikely complication

    • D. 

      Rapid correction of the hyponatremia may prevent central pontine injury

    • E. 

      This patient is best treated by restriction of water intake.

  • 8. 
    • A. 

      The total extracellular fluid volume represents 40% of the body weight.

    • B. 

      The plasma volume constitutes one fourth of the total extracellular fluid volume

    • C. 

      Potassium is the principal cation in extracellular fluid.

    • D. 

      The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid

    • E. 

      The interstitial fluid equilibrates slowly with the other body compartments.

  • 9. 
    1.       Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
    • A. 

      The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.

    • B. 

      With normal renal function, this patient is likely to be volume overloaded.

    • C. 

      Proper fluid therapy would be unlikely to include potassium administration

    • D. 

      Insulin administration will increase the potassium content of cells.

    • E. 

      Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.

  • 10. 
    Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
    • A. 

      Age over 70 years.

    • B. 

      Chronic malnutrition.

    • C. 

      Controlled diabetes mellitus.

    • D. 

      Long-term steroid use.

    • E. 

      Infection at a remote body site.

  • 11. 
    • A. 

      Myocardial infarct 4 months previously.

    • B. 

      Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin.

    • C. 

      Premature atrial or ventricular contractions on electrocardiogram

    • D. 

      A harsh aortic systolic murmur.

    • E. 

      Age over 70 years.

  • 12. 
    • A. 

      Whole blood is the most commonly used red cell preparation for transfusion in the United States.

    • B. 

      Whole blood is effective in the replacement of acute blood loss.

    • C. 

      Most blood banks in the United States have large supplies of whole blood available.

    • D. 

      The use of whole blood produces higher rates of disease transmission than the use of individual component therapies

  • 13. 
    • A. 

      Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.

    • B. 

      Two units of FFP should be given with every 5 units of packed red blood cells in most cases

    • C. 

      A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.

    • D. 

      One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.

    • E. 

      One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.

  • 14. 
     The evaluation of a patient scheduled for elective surgery should always include the following as tests of hemostasis and coagulation:
    • A. 

      History and physical examination.

    • B. 

      Complete blood count (CBC), including platelet count

    • C. 

      Prothrombin time (PT) and activated partial thromboplastin time (APTT).

    • D. 

      Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine

  • 15. 
    • A. 

      An allergic reaction.

    • B. 

      An anaphylactoid reaction.

    • C. 

      A clerical error.

    • D. 

      An acute bacterial infection transmitted in blood.

  • 16. 
    • A. 

      This formulation is proposed for the use of patients with fulminant hepatitis

    • B. 

      Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.

    • C. 

      The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy

    • D. 

      In some studies of surgical patients, improvements in mortality have been reported.

  • 17. 
    • A. 

      Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow

    • B. 

      In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.

    • C. 

      Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition

    • D. 

      Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.

  • 18. 
    • A. 

      In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated

    • B. 

      In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.

    • C. 

      In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.

    • D. 

      CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support

  • 19. 
    • A. 

      Gallstones occur with the same frequency in diabetes patients as in the healthy population.

    • B. 

      The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.

    • C. 

      Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.

    • D. 

      The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.

    • E. 

      Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.

  • 20. 
    • A. 

      Prevents the aggressive development of atherosclerosis in diabetic patients

    • B. 

      Is not associated with unawareness of hypoglycemia.

    • C. 

      Improves peripheral neuropathy

    • D. 

      Improves established retinopathy and nephropathy

    • E. 

      Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).

  • 21. 
    What is the major determinant in an individual patient's risk for perioperative complications?
    • A. 

      The surgical procedure.

    • B. 

      The length of the surgical procedure.

    • C. 

      The anesthetic technique (e.g., general, regional).

    • D. 

      The length of anesthesia.

    • E. 

      All of the above.

  • 22. 
    Advantages of epidural analgesia include:
    • A. 

      Earlier mobilization after surgery.

    • B. 

      Earlier return of bowel function.

    • C. 

      Shorter hospitalizations.

    • D. 

      Decreased stress response to surgery.

    • E. 

      All of the above

  • 23. 
    • A. 

      Protein depletion.

    • B. 

      Infection

    • C. 

      Anemia

    • D. 

      Advanced age.

    • E. 

      Hypoxia

  • 24. 
    • A. 

      Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes

    • B. 

      Lymphocytes are the primary blood cell involved with this process

    • C. 

      The process involves a coating of the cytoplasmic surface known as clathrin

    • D. 

      Phagocytosis is performed only by white blood cells and tissue macrophages

  • 25. 
    • A. 

      The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration

    • B. 

      The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium

    • C. 

      The selectivity of biologic membranes is highly consistent and seldom changes

    • D. 

      The selectivity of cell membranes relates only to ions and not organic compounds